HEALTH CARE/Joan Retsinas

More Words on the A Word

In the Congressional wrangling over health reform, abortion is taking center stage, as legislators cloak the procedure in emotion-laden words. Infanticide? Zygoticide? Legal right? Moral duty? Anathema? Ethicists debate the timing of the soul, the implantation of cells in the uterus, the viability of the squiggle on the ultrasound. The words spew forth.

Im old enough to remember when abortion was illegal. Contraception too. (Remember Bill Baird? The founder of the nations first abortion referral and birth control clinic in 1964, when both practices were still illegal in New York, could be a name in a Trivial Pursuit game.) The status of oldster hasnt given me wisdom  certainly not wisdom to debate such far-reaching conundrums as the birth of a soul  but it has given me pragmatism. So, here are more words on the A word.

Please discard the moral cloak. Consider abortion a procedure. But recognize it as demand-driven. Women seek it out. Their reasons run the gamut  from convenience to desperation; but until somebody has walked in those womens shoes, they should hesitate to condemn the demand. A man who has never been pregnant with a child he cannot support, never watched a newborn with Tay-Sachs slowly die, or been raped should hesitate to condemn the woman who doesnt want to give birth to the fetus growing within her.

Eliminating the supply of abortion services will not squelch the demand. If a right-thinking Congress managed to outlaw abortion  not only make it illegal for anybody to pay for one, but make it illegal for anybody to perform one, women would still seek them. They would go to expensive obstetricians who would perform the procedure as a D and C, or to back-alley hacks who would do the same, often in un-sterile conditions. They would take herbal concoctions. They would re-discover coat hangers. Some women would go abroad. Remember Sherri Finkbine? (Another Trivial Pursuit name. The TV actress had to go to Sweden in 1962 to get an abortion after discovering that her Thalidomide-deformed fetus would be born without legs and one arm.) Women would travel back to that pre-Roe v. Wade golden age that right-thinking conservatives extol.

If we as a nation truly wanted to eliminate all abortions, we would have to charge the women seeking them with murder  maybe throw the women in jail, fine them, or fill orphanages with abandoned children, à la Romania (which famously barred contraception as well as abortion).

Recent medical advances have advanced the legitimacy of abortion. Thanks to emergency contraception, women who have been raped dont need to hold their breath to see whether the rape resulted in an embryo. Similarly, women who regret a sexual encounter can end the relationship with a pill. We can identify a host of genetic anomalies before birth; one result of that genetic screening is abortions.

So abortion is part of the American medical landscape. The Guttmacher Institute estimates that 22% of all pregnancies end in abortion (excluding miscarriages). In 2005, 2.1 million women sought abortions; 78% of the women reported a religious affiliation.

Nevertheless, Im willing to give up insurance coverage of abortion to save health reform. Currently the millions of Americans without insurance are effectively barred from a host of services: chemotherapy, insulin, diagnostic imaging, laboratory tests, any kind of rehabilitation, surgery. Even contraception. In fact, with universal coverage, the number of abortions may drop when more Americans have ready access to contraception. Abortion is a relatively low-cost procedure, one that might come under a deductible. (Analysts suggest that many insured women pay out-of-pocket for the procedure.)

If Congress sacrifices abortion for universal health coverage, I suspect, and hope, that the pro-life victory will be Pyrrhic. The politicians who voted to stop funding abortions may well discover powerful opposition at the next election, when women who have had abortions, know friends and relatives who have had them, or been pleased that they had the choice rush to unseat the officials avid to deny that choice. Those women will elect legislators who will re-instate abortion as a medical procedure, one that insurance will cover. The legions of men who have supported women in their choices will join this crusade. In a decade, a trivial pursuit player will ask: What was the Stupak Amendment?

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.